Prevention and Treatment of Chemotherapy-Induced Alopecia: What Is Available and What Is Coming?

Abstract

Millions of new cancer patients receive chemotherapy each year. In addition to killing cancer cells, chemotherapy is likely to damage rapidly proliferating healthy cells, including the hair follicle keratinocytes. Chemotherapy causes substantial thinning or loss of hair, termed chemotherapy-induced alopecia (CIA), in approximately 65% of patients. CIA is often ranked as one of the most distressing adverse effects of chemotherapy, but interventional options have been limited. To date, only scalp cooling has been cleared by the US Food and Drug Administration (FDA) to prevent CIA. However, several factors, including the high costs not always covered by insurance, preclude its broader use. Here we review the current options for CIA prevention and treatment and discuss new approaches being tested. CIA interventions include scalp cooling systems (both non-portable and portable) and topical agents to prevent hair loss, versus topical and oral minoxidil, photobiomodulation therapy (PBMT), and platelet-rich plasma (PRP) injections, among others, to stimulate hair regrowth after hair loss. Evidence-based studies are needed to develop and validate methods to prevent hair loss and/or accelerate hair regrowth in cancer patients receiving chemotherapy, which could significantly improve cancer patients’ quality of life and may help improve compliance and consequently the outcome of cancer treatment.

A cross‐sectional analysis of medications used by patients reporting alopecia areata on the FDA adverse events reporting system

“…15 Patients on such treatments typically present with chemotherapy-induced alopecia, which has an estimated incidence rate of roughly 65%. 15,16 Without clinical evaluation by a dermatologist and dermoscopy, it is challenging to verify whether the cases reported on the FAERS were actual AA as it would be much lower on the differential. Additionally, the nuance between various types of alopecia is tricky and can require a specialist in trichology to identify the condition accurately.…”

How I Treat Alopecia in Patients with Cancer

“…[7][8] Encouraging results from smaller studies also highlight the efficacy of oral/topical dutasteride and oral/topical spironolactone. [8][9] Importantly, there is a theoretical concern that oral spironolactone or 5-α reductase inhibitors may increase hormonal stimulation of estrogen receptor-positive tumors; more extensive research is needed to fully assess potential adverse effects. For this reason, we limit use of these medications to topical applications in patients with EIA.…”

“…For this reason, we limit use of these medications to topical applications in patients with EIA. A pilot study on the effectiveness of PRP for the treatment of EIA is currently underway, 9 and we consider PRP when patients cannot tolerate minoxidil or when patients plateau. Notably, patients on combined CDK4/6 inhibitor + endocrine therapy regimens demonstrated more recalcitrant EIA compared to those receiving monotherapy, necessitating oral minoxidil, often a doses of 2.5 to 5 mg, for optimal management.…”

The role of telomerase in hair growth and relevant disorders: A review

“…One of the most serious and significant side effects of chemotherapy is hair loss, approximately 65% of patients receiving chemotherapy experience chemotherapy-induced alopecia (CIA). 36 And to make matters worse, a small number of CIA is irreversible, and some patients even refuse chemotherapy for fear of CIA. The emergence of the CIA may be related to the suppression of telomere function by chemotherapy drugs exerting anticancer effects.…”